File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

Tell family and friends about your condition

Provide disaster relief

Include you in a hospital directory

Provide mental health care

Market our services and sell your information

Raise funds

Our Uses and Disclosures

We may use and share your information as we:

Treat you

Run our organization

Bill for your services

Help with public health and safety issues

Do research

Comply with the law

Respond to organ and tissue donation requests

With a medical examiner or funeral director

Address worker’s compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and billing records. Contact the Health Information Management Department.

We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. We follow PA Act 126 pertaining to the charging for photocopies of medical records. The hospital reserves the right to request payment in advance for copying and mailing fees.

The hospital has the right to deny access to your protected health information. If your request is denied, we will provide you with an explanation.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. Requests for amendments must be submitted in writing to the Privacy Officer. The request should state the specific change and describe the reason for the change.

We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

To exercise your right, your written request should be submitted to the Privacy Officer and should specify the applicable time frame you are requesting. Upon receipt of the written request, the Hospital is required to respond within 30 days. If we cannot comply, we will notify you in writing, explaining the reason for the delay.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us:Privacy OfficerLehigh Valley Health Network420 South Jackson StreetPottsville, PA 1790570-621-5193

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

Share information with your family, close friends, or others involved in your care

Share information in a disaster relief situation

Include your information in a hospital directory – We may include certain limited information about you in the hospital directory while you are a patient at the hospital. The directory may include your name, location in the hospital, your general condition, and your religious affiliation. The directory information, excluding religious affiliation, may be disclosed to people who ask for you by name unless you request us not to release any part or all of this information.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

Marketing purposes

Sale of your information

Most sharing of psychotherapy notes

In the case of fundraising:

We may contact you for fundraising efforts. We may use and disclose with our development office or a business associate that is related to us your name, address, phone number, and other such information (called demographic information) and dates that health care was provided to you. This information may be used to solicit a donation from you. Any fund-raising materials will explain how you can tell us or a business associate that you do not want to be contacted in the future. If you do so, we will use reasonable efforts to avoid contacting you in the future.

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

Appointment Reminders

We may use and disclose information to remind you about upcoming appointments or treatment or services at one of our facilities.How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as:

Preventing disease

Helping with product recalls

Reporting adverse reactions to medications

Reporting suspected abuse, neglect, or domestic violence

Preventing or reducing a serious threat to anyone’s health or safety

To maintain vital records such as birth or death

To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence as provided for by Pennsylvania law

Health Oversight Activities

We may disclose information about you to a health oversight agency for activities such as audits, inspections, investigations, and licensure. These activities are necessary for the government to monitor programs and compliance with civil rights laws.

Do research

We can use or share your information for health research.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

For workers’ compensation claims

For law enforcement purposes or with a law enforcement official

With health oversight agencies for activities authorized by law

For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Respond to Law Enforcement

We may release information about you if asked to do so by a law enforcement official:

To identify suspects, witnesses, or missing persons

About the victim of a crime

About deaths we believe may be the result of criminal activity

About criminal conduct at any of our facilities

In a emergency to report a crime, crime victim, or the individual who committed a crime

Respond to Inmates

If you are an inmate of a correctional facility we will release information about you to the correctional institution or law enforcement official.

National Security and Protection of the President and Others

We may disclose protected health information to federal officials for purposes of conducting national security activities and protecting the President and other dignitaries.

Business Associates

We may utilize individuals or companies to perform a function or activity on our behalf. We may disclose protected health information to our business associates and allow them to create and receive protected health information. This business associate arrangement is outlined in a business associate agreement between both parties to protect the privacy of protected health information.

Other Uses of Medical Information

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us with permission to use or disclose information about you, you may revoke that permission, in writing, at any time. You understand that we are unable to “take back” any disclosures that we have already made with your permission and that we are required to keep any records of the care that we provided to you.

Pennsylvania State Law requires special authorization to release information related to the testing, diagnosis, and/or treatment of any of the following conditions:

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site at http://www.schuylkillhealth.com